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目的对比超声弹性成像应变率比值与硬度分级鉴别诊断甲状腺良恶性结节的临床价值。方法选取我院收治的114例甲状腺良性结节患者、135个结节(对照组),119例甲状腺恶性结节患者、141个结节(病例组)作为研究对象。所有结节术前均接受超声弹性成像检查,以病理检查为甲状腺良恶性结节鉴别诊断的金标准,绘制应变率比值、硬度分级鉴别诊断甲状腺良恶性结节的受试者工作特征曲线(ROC曲线),求得ROC曲线下面积(AUC)、最佳鉴别诊断阈值以及对应的灵敏度、特异度等指标。结果 (1)病例组应变率比值、硬度分级显著高于对照组,两组差异有统计学意义(P<0.05)。(2)应变率比值鉴别诊断甲状腺良恶性结节的AUC为0.895,其95%可信区间(CI)为0.865~0.949。结节硬度分级鉴别诊断甲状腺良恶性结节的AUC为0.882,其95%CI为0.859~0.937。应变率比值、硬度分级的AUC比较差异无统计学意义(P>0.05)。(3)应变率比值鉴别诊断甲状腺良恶性结节的最佳鉴别诊断阈值为3.14,其对应的灵敏度、特异度分别为85.11%、89.63%。硬度分级鉴别诊断甲状腺良恶性结节标准≤Ⅱ级为良性,>Ⅱ级为恶性,其对应的灵敏度、特异度分别为83.69%、88.89%。结论超声弹性成像应变率比值与硬度分级鉴别诊断甲状腺良恶性结节的临床价值相当,两个指标均有良好的灵敏度及特异度。
Objective To compare the diagnostic value of ultrasonic elastography strain rate ratio and hardness grade in the diagnosis of benign and malignant thyroid nodules. Methods A total of 114 patients with benign thyroid nodules, 135 nodules (control group), 119 patients with malignant thyroid nodules and 141 nodules (case group) were enrolled in this study. All nodules underwent echocardiography preoperatively. The pathological examination was the gold standard for the differential diagnosis of benign and malignant thyroid nodules, and the strain rate ratio was plotted. The receiver operating characteristic curve (ROC) of differential diagnosis of benign and malignant thyroid nodules Curve), get the area under the curve (AUC) ROC curve, the best differential diagnosis threshold and the corresponding sensitivity, specificity and other indicators. Results (1) The strain rate ratio and hardness grade in the case group were significantly higher than those in the control group, with significant difference between the two groups (P <0.05). (2) The AUC of benign and malignant thyroid nodules in differential diagnosis was 0.895, and the 95% confidence interval (CI) was 0.865-0.949. The AUC of benign and malignant thyroid nodules in differential diagnosis of nodularity was 0.882, and the 95% CI was 0.859-0.937. There was no significant difference in AUC between strain rate and hardness (P> 0.05). (3) The best differential diagnosis threshold of benign and malignant thyroid nodules with differential diagnosis ratio is 3.14, the corresponding sensitivity and specificity are 85.11% and 89.63% respectively. The differential diagnosis of benign and malignant thyroid nodules grade benign and malignant nodules grade Ⅱ benign, grade Ⅱ malignant, the corresponding sensitivity and specificity were 83.69%, 88.89%. Conclusion The clinical value of ultrasonic elastography strain rate ratio and hardness grade differential diagnosis of benign and malignant thyroid nodules are quite similar. Both indexes have good sensitivity and specificity.